What about this idea: all hospital administrators, program directors, and DIOs at sponsoring institutions are charged some fee that comes out of their paychecks to pay into a fund to help support displaced residents?
My point, which you don't seem to like, is that many industries work like this, sometimes through a union. The union collects dues from it's members, and then offers financial protection in cases of strikes, etc. If we want to have a fund to pay for displaced resident costs, then someone needs to decide who pays for it and what it covers. It's "easy" to suggest that other people should pay for it, rather than the people who would get the benefit. If programs/institutions decide to do this (or if the ACGME mandates it), then it's very likely that those costs will be passed onto residents via decreases in salary increases. Or, residents could get together to do this themselves. In either case, one would need to decide what it covers -- malpractice? lease temination costs? unemployment if you don't find a new job? moving costs? a fixed amount of money for everyone? (which would be simplest, but might be "unfair" as someone who gets a spot at the hospital down the road might have no costs). And what happens if the fund runs dry? It's not so easy.
Why should residents be charged? And the wording of the clause with the sponsering institution seems to suggest that they should still be on the hook. There are residents who graduated in June, etc.-shouldn't the sponsering institution be on the hook?
So your solution is to take residents, who already are the lowest people on the totem pole, and charge them for this? Everyone else is off the hook? Even the people who VIOLATED their contract (stated we would have occurance based, yet gave us claims based)? I'm sorry is this how program directors/adminstration views residents? The same people who preach about physicians of this day and age have no financial responsibility. You've got to be kidding me. The wording, at least to me suggests the sponsering institution should have some role in this. But let's assume they don't-I'm not a lawyer and I may be missing something. There is no moral obligation in your mind of physicians to protect their own? They can just let this happen with impugnity? And your solution is to make RESIDENTS across the country pay?
The sponsoring institution is still "on the hook", but is bankrupt. Lots of people won't get paid what they are owed. If Hahnemann contracts stated there would be occurrence based insurance and they did something else, they didn't live up to that contract. The guilty party here is Hahnemann. The problem is, they are bankrupt so it's impossible / difficult to make them pay as lots of creditors are going to be in line for their assets. If Drexel was actually part of their contracts, then they too are responsible.
Perhaps, as I also mentioned, the solution going forward is for the ACGME to create a fund to deal with issues like this. But history shows that many bailout funds end up running dry, and as I mentioned new costs tend to get passed down. Zappos has free shipping both ways -- but it's not really free, ultimately shoppers pay for it in prices.
Why would ACGME be nervous doing this? After this debacle, they should be reviewing every program's insurance policy to make sure this crap never happens again. I suspect this will end up being like the 737 MAX incident....takes a couple plane crashes but you can bet Boeing isn't gonna let another safety issue slip through production for the next 100 years.
The ACGME will be nervous about doing this because if they bail out this program, then the next one to go bankrupt will demand the same thing. And once the ACGME is bailing out programs/residents, then programs will feel like they don't have to help at all.
As I mentioned earlier, there was nothing wrong with Hahnemann's insurance (ignoring the issue of whether their contracts stated it was "claims made" vs "occurrence". Claims made insurance is fine, you just need to pay for tails as your residents leave - unless I've missed something in the program requirements. Plus, if I remember the news articles correctly, Hahnemann might have changed to claims made mid year so perhaps when the ACGME visited they were fine. My institution is self insured, so I have no idea how the ACGME would even evaluate this.
I think this depends a lot on how the residency is set up. My residency program I was paid through and employed by the medical school (including my chief year, in which I had three separate employment contracts to cover both my clinical and administrative work), but was contracted out to the hospital for labor, since the medical school itself didn't own the hospital. This was the case with all the residencies and fellowships at this medical school (which was complicated by the fact that residents were working at at least three different hospital systems, and the attendings were pseudo private practice...).
My fellowship is run by the hospital, not the affiliated medical school, but I'm in pediatrics and am at a stand-alone children's hospital--I think the adult residencies and fellowships are run through the medical school.
These types of details would be very helpful in the discussion of whether Drexel is on the hook here.
---
Much of this discussion revolves around whether you see this issue as a legal problem, or a moral problem. It's both, of course, but which is preeminent.
If you see it as a legal problem, then the question is whom is legally responsible. Obviously Hahnemann is the primary actor, but they are bankrupt. So the question is who else is legally responsible. Drexel may be depending on the contracts. The ACGME might be if you can prove that their oversight was lacking. I don't see the NRMP having any legal responsibility here, nor the AMA or AAMC.
If you see it as a moral problem, then it doesn't matter whom is legally responsible. The argument is that the profession has a moral responsibility to financially support displaced residents. In that case, all of the groups listed above are part of the profession, and "should" find a solution.
Personally, I'd like to see a solution managed by the ACGME. This will probably require funding by charging institutions higher fees. Those fees might result in lower resident salaries/benefits. Increased fees might trigger more programs to close, or might encourage programs to switch to claims made insurance figuring that they will just get "bailed out if something goes wrong". Determining what costs should be covered, and limits, is a difficult task. In this case alone, if a tail is an average of $10K (a number I just made up, no idea if it is accurate), and there were 540 residents @ Hahnemann, that's $5.4 million -- and that's just the medmal costs. Building a war chest that can withstand those types of costs won't be easy, or cheap. And many hospitals budgets just skim trees.